Discrepancy in medications reported by elderly patients in the dental office and in their electronic medical records: A pilot study.

AIMS: This study's main objective was to analyze the discrepancy between the dental medication record (DMR) and the physician-prescribed active medications recorded in the medical medication record (MMR). METHODS: The study group consisted of 100 adults who attended the University Dental Clinic (Santiago de Compostela, Spain) requesting dental care. A dental history was created for all participants that included the DMR. The MMR were compiled from their electronic medical records. RESULTS: About 80% of the patients consumed at least one drug (94.2% of those >65 years) and 19% took more than five drugs (26.4% of those > 65 years). In total, 54% of the patients had some discrepancy between the medications recorded in the DMR and those in the MMR (48.4% for those ≤65 years and 64.7% for those >65 years). The rate of participants who omitted some drugs was higher for those >65 years. The drugs most omitted from the DMR were analgesics/opioids, antihypertensives and anxiolytics/hypnotics/sedatives. CONCLUSIONS: It is imperative to access the MMR of patients requesting dental care because a significant number of medications are not reflected in their DMR. These discrepancies may be particularly common and relevant in elderly patients, in whom multimorbidity and polypharmacy are more frequent.

A practical approach to dental care for patients with Wolf-Hirschhorn syndrome.

Wolf-Hirschhorn syndrome is a polymalformative chromosomal disorder caused by a deletion in the distal region of the short arm of chromosome 4. The disease is considered rare (1/50,000 births) and predominantly affects females (2:1). In addition to the characteristic facial phenotype ("Greek warrior helmet"), its clinical manifestations include epilepsy, developmental and psychomotor delay, intellectual disability, cardiac and respiratory complications, and eating problems. The most prevalent oral manifestations are hypodontia, delayed tooth eruption, morphological dental abnormalities, dental malocclusions, cleft lip/palate and ogival palate. Based on our clinical experience, Wolf-Hirschhorn syndrome does not represent an absolute contraindication for any type of dental procedure. The feasibility of dental treatment will depend mainly on the degree of epilepsy control and on the level of collaboration, this latter conditioned by the severity of the intellectual disability and communication difficulties.

Evaluación de la calidad de la información disponible en Internet sobre odontología y síndrome de Down / Evaluation of the quality of the information available on the Internet regarding dentistry and Down syndrome

No disponible

Mandibular cortical indices on cone-beam computed tomography images in osteoporotic women on treatment with oral bisphosphonates.

OBJECTIVE: To evaluate the mandibular cortical indices in osteoporotic women receiving oral bisphosphonates (oBPs). MATERIAL AND METHODS: The study group included 46 Caucasian women aged over 55 years on treatment with oBPs for postmenopausal osteoporosis. Information recorded included age, weight, height, type of oBP, duration of treatment, comorbid conditions and coadjuvant medication. Forty-six age-matched Caucasian women with no known diagnosis of osteoporosis were selected as the control group. All participants underwent cone-beam computed tomography, and the mandibular cortical width (MCW) and the height from the inferior mandibular border to the mental foramen (MBMF) were measured. RESULTS: The MBMF was similar in the participants with osteoporosis and in controls. MCW was significantly greater in the participants with osteoporosis than in the controls (p < 0.001). CONCLUSION: Mandibular cortical width should not be used to predict the risk of bisphosphonate-associated osteonecrosis of the jaws.

Criteria for the prescription of oral bisphosphonates for the treatment of osteoporosis in a series of women referred for tooth extraction

Objective: To evaluate the criteria for the prescription of oral bisphosphonates (OB) in a series of women with osteoporosis referred for tooth extraction. Study design: The study included 38 postmenopausal women on treatment with OBs. The following variables were analysed: age, weight, height, type of OB and duration of treatment, bone densitometry and risk factors for osteoporosis. In addition, the osteoporosis self-assessment tool (OST) was administered and collagen type I Ctelopeptide (CTX) levels were measured.Results: Bone densitometry had only been performed in six patients (15.7%) before starting OB treatment. Based on the results of the OST, nine (23.6%) of the participants presented a low risk of osteoporosis. CTX levels were measured in 23 patients: 11 (47.8%) presented values below 150 pg/ml.Conclusion: Although all patients in the present series were on treatment with OBs, a large percentage did not satisfy the criteria for the initiation of treatment for postmenopausal osteoporosis (AU)

Criteria for the prescription of oral bisphosphonates for the treatment of osteoporosis in a series of women referred for tooth extraction.

OBJECTIVE: To evaluate the criteria for the prescription of oral bisphosphonates (OB) in a series of women with osteoporosis referred for tooth extraction. STUDY DESIGN: The study included 38 postmenopausal women on treatment with OBs. The following variables were analysed: age, weight, height, type of OB and duration of treatment, bone densitometry and risk factors for osteoporosis. In addition, the osteoporosis self-assessment tool (OST) was administered and collagen type I C-telopeptide (CTX) levels were measured. RESULTS: Bone densitometry had only been performed in six patients (15.7%) before starting OB treatment. Based on the results of the OST, nine (23.6%) of the participants presented a low risk of osteoporosis. CTX levels were measured in 23 patients: 11 (47.8%) presented values below 150 pg/ml. CONCLUSION: Although all patients in the present series were on treatment with OBs, a large percentage did not satisfy the criteria for the initiation of treatment for postmenopausal osteoporosis.

Cambios en los hábitos de salud oral en pacientes infectados por el virus de la inmunodeficiencia humana / Changes in the oral health habits in patients with the human immunodeficiency virus

Objetivo: Analizar los cambios en la frecuencia de cepillado y demanda de atención odontológica en un colectivo de pacientes VIH-positivos sometidos a seguimiento durante un largo período de tiempo. Pacientes y método: El grupo de estudio lo conformaron 200 individuos VIH-positivos. En 1992 se les realizó una exploración odontológica y una encuesta sobre frecuencia de cepillado dental y visitas al dentista, antes de la seroconversión y en ese año. En 2002, se reexaminó y reencuestó a 56 pacientes, para analizar la actitud de este colectivo hacia los cuidados odontológicos y compararla con la de la población general española. Resultados: La higiene oral mejoró significativamente a lo largo del período de seguimiento (el 45 por ciento del colectivo no se cepillaba diariamente antes de la seroconversión; frente al 25 por ciento en 1992 y al 13 por ciento en 2002). El número de enfermos que visitaba regularmente al dentista aumentó un 15 por ciento entre 1992 y 2002. Conclusión: Los hábitos de higiene y el estado de salud oral de los pacientes VIH-positivos de largo tiempo de evolución son similares a los de la población general (AU)

Chemoprophylaxis of bacterial endocarditis recommended by general dental practitioners in Spain.

The aim of this study was to assess the current practice of antibiotic prophylaxis of Bacterial Endocarditis (BE) among General Dental Practitioners (GDPs) in Spain. GDPs were asked over the telephone by a fictitious patient what antibiotic prophylaxis they would administer to an "at risk" patient for BE before a tooth extraction. Four hundred randomly selected Spanish GDPs were surveyed, 200 of them were asked about BE prophylaxis in penicillin non-allergic patients and the remaining 200 in penicillin allergic patients. Of the GDPs surveyed, 182 (45.5%) did not recommend any prophylactic treatment; 74.7% of those stated that an oral examination before treatment was needed and 25.3% referred the patient to his/her physician or cardiologist for further advice. Of the 97 GDPs who recommended antibiotics to penicillin nonallergic patients, only 30 (30.9%) suggested the prophylactic guidelines proposed by the American Heart Association or the British Society for Antimicrobial Chemotherapy. For penicillin allergic patients, 68.2% of the GDPs prescribed erythromycin as the antibiotic of first choice, while 17.6% of the GDPs prescribed clindamycin. Nonetheless, fewer than 30% administered both antibiotics with the adequate dosages. These results show important gaps in the knowledge of antibiotic prophylaxis for "at risk" patients before dental procedures among Spanish GDPs.

Pautas de profilaxis antibiótica de Endocarditis Bacteriana, recomendadas por los odontólogos en España / Chemoprophylaxis of bacterial endocarditis recommended by general dental practitioners in Spain

El propósito del presente estudio fue conocerlas pautas de profilaxis antibiótica de Endocarditis Bacteriana (EB) recomendadas por los odontólogos en España. Se preguntó a través de una llamada telefónica, cuál era el régimen profiláctico que se debía administrar a un paciente de riesgo de EB antes de someterse a una exodoncia. La información se obtuvo de 400 odontólogos seleccionados aleatoriamente y distribuidos por todo el territorio español. A 200 se les preguntó sobre la pauta recomendada en pacientes no alérgicos a la penicilina y, a los 200 restantes, sobre la aplicada en los alérgicos a la penicilina. Del total de encuestados, 182 (45,5 por ciento) no sugirieron ningún régimen profiláctico, de éstos el 74,7 por ciento señalaron la necesidad de una cita para una exploración previa y el 25,3 por ciento refirieron al paciente a su médico general o cardiólogo. De los 97 odontólogos que recomendaron antibióticos para pacientes no alérgicos a la penicilina, solamente 30 (30,9 por ciento) contestaron correctamente algún régimen profiláctico de los publicados por la Asociación Americana de Cardiología o la Sociedad Británica de Quimioterapia Antimicrobiana. Para pacientes alérgicos a la penicilina, el 68,2 por ciento de los odontólogos recomendaron eritromicina como antibiótico de elección, y el 17,6 por ciento clindamicina. Sin embargo, menos del 30 por ciento prescribieron estos antibióticos en las posologías correctas. Estos resultados demuestran una importante carencia de conocimientos entre los odontólogos españoles sobre las pautas de profilaxis de EB para pacientes de riesgo que van a someterse a una manipulación dental (AU)

Pre-assessment of severely handicapped patients suitable of dental treatment under general anesthesia.

OBJECTIVE: To analyze the importance of an individualized preoperative assessment in severely handicapped patients suitable of dental treatment under general anesthesia (GA). DESIGN: The study group consisted of 564 patients referred to a Special Needs Unit specialized in the dental care of handicapped people, who would be treated under GA. Medical and dental records of every patient were evaluated, as well as the findings in the oral examination and the assessment carried out by the anesthesiologists. RESULTS: Approximately 15% of patients (n=84) did not have any dental needs at the time of the examination; 42% (n=234) underwent treatment under GA and 43% (n=242) were treated under local anesthesia. Only 1.7% of the patients liable to undergo GA were discharged by the anesthesiologist due to their systemic condition. Medical and dental complications were scarce and, generally mild. During the follow-up period (mean 44 +/- 6 months) 4.8% of patients needed another treatment session under GA due to new dental pathology. CONCLUSION: Applying systematic selection criteria to perform any dental treatment under GA in severely handicapped patients reduces the indiscriminate use of this technique, minimizing complications as well as the necessity of new interventions.

Evaluación preanestésica de discapacitados severos susceptibles de tratamiento odontológico bajo anestesia general / Pre-assesment of severely handicapped patients suitable of dental treatment under general anesthesia

Objetivo: Analizar la importancia de la exploración preoperatoria individualizada de pacientes discapacitados severos susceptibles de tratamiento odontológico bajo Anestesia General (AG). Diseño: El grupo de estudio lo conformaron 564 pacientes remitidos a un centro especializado en la atención odontológica de pacientes especiales, para recibir tratamiento odontológico bajo AG. Se analizaron retrospectivamente los antecedentes médicos y odontológicos de todos los pacientes, así como los hallazgos de la exploración oral y los informes derivados de la consulta de anestesiología. Resultados: El 15 por ciento de los pacientes (n=84) no necesitaba tratamiento odontológico en el momento de la exploración. En el 42 por ciento de los rasos (n=234) el tratamiento se re-lizo bajo AG y en e143 por ciento de los pacientes (n=242) con Anestesia Local. De los enfermos susceptibles de AG sólo el l,7 por ciento fue excluido por el anestesiólogo en base a su compromiso médico. Las complicaciones tanto médicas como odontológicas fueron escasas y en general de baja intensidad. Durante el período de seguimiento (media 44 ñ 6 meses) en el 4,8 por ciento de los pacientes fue necesaria una nueva intervención bajo AG por la presencia de nueva patología dentaria. Conclusión: La aplicación sistemática de criterios de selección para efectuar tratamientos odontológicos bajo AG a discapacitados severos reduce el uso indiscriminado de esta técnica de control conductual, minimizando las complicaciones y la necesidad de reintervenciones (AU)